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Development and evaluation of a patient decision aid for pediatric interval appendectomy

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World Journal of Pediatric Surg.ry 2022年第4期5卷 275-281页

作者： Victoria Larocca Irina Oltean viviane g.andpierre Ahmed nasr Children's Hospital of Eastern Ontario Research Institute OttawaOntarioCanada Pediatric Surg.ry Children's Hospital of Eastern OntarioOttawaOntarioCanada

Objective One option for the treatment of perforated appendicitis in pediatric patients is interval appendectomy(IA).A patient decision aid(PDA)can be useful in the decision-making.process reg.rding.*** purpose of this study was to evaluate parents’decisional conflict before and after eng.g.ng.with a developed *** Participants included(a)parents who are considering.IA surg.ry for their child,(b)have not yet had their follow-up appointment postdischarg.,and(c)were fluent in either the official lang.ag.s of Eng.ish or *** study used a pretest and post-test desig. to measure participants’decisional conflict and treatment option *** and acceptability of the PDA were also *** A total of 18 participants completed the study(16 mothers).Major finding. include sig.ificant decreases in all Decisional Conflict Scale items from pre-PDA to post-PDA eng.g.ment,except for one *** majority of participants perceived the PDA to be useful,easy to find information reg.rding.risks and provided enoug. information to help them make a decision reg.rding.their child’s *** This is the first study to develop and evaluate a PDA among.parents who are making.a decision reg.rding.IA *** results showed a sig.ificant decrease in decisional conflict after using.the *** results also showed that the PDA was g.nerally accepted among.parents and had positive perceptions reg.rding.leng.h,content,and *** use of PDA for this population can help ease feeling. of decisional conflict and equip parents with the information to make informed decisions.

关键词： decision enoug. conflict

Addressing.barriers to evidence- based medicine in pediatric surg.ry: an introduction to the Canadian Association of Paediatric Surg.ons Evidence- Based Resource

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World Journal of Pediatric Surg.ry 2022年第1期5卷 25-29页

作者： viviane g.andpierre Irina Oltean Manvinder Kaur Ahmed nasr Department of Surg.ry Children's Hospital of Eastern OntarioOttawaOntarioCanada University of Ottawa OttawaOntarioCanada

Backg.ound Pediatric surg.cal practice lag. behind medicine in presence and use of evidence,primarily due to time constraints of using.existing.tools that are not specific to pediatric surg.ry,lack of sufficient patient data and unstructured pediatric surg.ry training.*** We developed,disseminated and tested the effectiveness of an evidence-based resource for pediatric surg.ons and researchers that provides brief,informative summaries of quality-assessed systematic reviews and meta-analyses on conflicting.pediatric surg.ry *** Responses of 91 actively practicing.surg.ons who used the resource were *** majority of participants found the resource useful(75%),improved their patient care(66.6%),and more than half(54.2%)found it useful in identifying.research *** all participants reported that the resource could be used as a teaching.tool(93%).Conclusion Lack of awareness of the resource is the primary barrier to its routine use,leading.to potential calls for more active dissemination *** of the Canadian Association of Paediatric Surg.ons Evidence-Based Resource find that the summaries are useful,identify research g.ps,help mitig.te multiple barriers to evidence-based medicine,and may improve patient care.

关键词： pediatric surg.ry routine

Predictors of spontaneous resolution of umbilical hernia in children

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World Journal of Pediatric Surg.ry 2021年第3期4卷 35-38页

作者： Manvinder Kaur viviane g.andpierre Irina Oltean Arielle Weir Ahmed nasr Department of Surg.ry Children's Hospital of Eastern OntarioOttawaCanada

Objective The aims were to describe the manag.ment of umbilical hernias,to define postoperative complications,and to identify the characteristics of patients that were more likely to have spontaneous resolution of their *** All patients referred for umbilical hernia at the Children’s Hospital of Eastern Ontario from January 1990 to April 2017 were examined via retrospective chart *** resolution of umbilical hernia was examined using.binary log.stic *** We included 2621 patients presenting.with an umbilical hernia.A total of 1587(60.5%)patients underwent surg.cal repair at a median ag. of 3.6 years(IQR 2.3-5.4).Surg.cal complications consisted of infection(n=3),bleeding.n=3),hematoma(n=3),and anesthesia-related complications(n=3).For every one-unit increase in defect size,the odds of a spontaneous resolution of the hernia were 5%lower while controlling.for prematurity and the presence of comorbidities[adjusted odds ratio(aOR)=0.95;95%confidence intervel(CI)0.93 to 0.97].Premature babies were 80%less likely to experience hernia resolution compared with non-premature babies(aOR=0.20;95%CI 0.03 to 0.74).Conclusion The odds of spontaneous resolution were lower for premature babies and were neg.tively correlated with defect size.

关键词： hernia anesthesia resolution

Postoperative complications of colectomy and J- pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta- analysis

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World Journal of Pediatric Surg.ry 2022年第2期5卷 38-45页

作者： Irina Oltean Nicole Travis Manvinder Kaur viviane g.andpierre Lamia Hayawi Anne Tsampalieros Ahmed nasr Department of Surg.ry Children's Hospital of Eastern OntarioOttawaOntarioCanada Children's Hospital of Eastern Ontario Research Institute Clinical Research UnitOttawaOntarioCanada University of Ottawa OttawaOntarioCanada

Backg.ound The efficacy of performing.a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting.ileostomy in children with inflammatory bowel disease has been a long.tanding.debate.A systematic review and meta-analysis is presented comparing.the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis(IPAA)with ileostomy(diverted)versus the undiverted *** Records were sourced from CINAHL,CENTRAL,EMBASE and MEDLINE *** followed the Preferred Reporting.Items for Systematic Reviews and Meta-Analyses g.idelines and compared postoperative complications in pediatric patients diag.osed with inflammatory diseases ag.d less than 18 years who underwent J-pouch with ileostomy versus without *** primary outcome was the occurrence of postoperative leaks,and the secondary outcomes were presence of postoperative small bowel obstruction(SBO),pouchitis,stricture and fistula complications.A random-effects meta-analysis was *** Twenty-three observational studies in the systematic review were included with 658 patients(83%diverted,17%undiverted).Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without(odds ratio(OR)0.54,95%confidence interval(CI)0.17 to 1.64,I^(2)=16%).There was no difference in the occurrence of SBO,pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without(SBO:OR 2.27,95%CI 0.52 to 9.92,I^(2)=0%,pouchitis:OR 1.76,95%CI 0.95 to 3.24,I^(2)=0%,strictures:OR 2.72,95%CI 0.44 to 16.69,I^(2)=66%).Conclusion The meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.

关键词： complications bowel diseases

Quality of life outcomes in children after surg.ry for Hirschsprung.disease and anorectal malformations:a systematic review and meta-analysis

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World Journal of Pediatric Surg.ry 2022年第4期5卷 204-210页

作者： Irina Oltean Lamia Hayawi Victoria Larocca Vid Bijelić Emily Beveridg. Manvinder Kaur viviane g.andpierre Jane Kanyinda Ahmed nasr Department of Surg.ry Children's Hospital of Eastern OntarioOttawaOntarioCanada Clinical Research Unit Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada

Backg.ound No systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life(QoL)in pediatric populations affected by Hirschsprung.s disease(HD)and anorectal malformations(ARM).The objective of this systematic review is to quantitatively summarize the parent-reported and child-reported psychosocial and physical functioning.scores of such *** Records were sourced from the CENTRAL,EMBASE,and MEDLINE *** that reported child and parent reported QoL in children with HD and ARM,reg.rdless of surg.ry intervention,versus children without HD and ARM,were *** primary outcome was the psychosocial functioning.scores,and the secondary outcomes were the presence of postoperative constipation,postoperative obstruction symptoms,fecal incontinence,and enterocolitis.A random effects meta-analysis was *** Twenty-three studies were included in the systematic review,with 11 studies included in the ***,1678 total pediatric patients with HD and ARM underwent surg.ry vs 392 healthy *** parent-reported standardized mean(SM)scores showed better social functioning.after surg.ry(SM 91.79,95%CI(80.3 to 103.3),I2=0).The pooled standardized mean difference(SMD)showed evidence for parent-reported incontinence but not for constipation in children with HD and ARM after surg.ry that had a lower mean QoL score compared with the normal population(SMD−1.24(-1.79 to–0.69),I2=76%and SMD−0.45,95%CI(−1.12 to 0.21),I2=75%).The pooled prevalence of child-reported constipation was 22%(95%CI(16%to 28%),I2=0%).The pooled prevalence of parent-reported postoperative obstruction symptoms was 61%(95%CI(41%to 81%),I2=41%).Conclusion The results demonstrate better social functioning.after surg.ry,lower QoL scores for incontinence versus controls,and remaining.constipation and postoperative obstruction symptoms after surg.ry in children with HD and ARM.

关键词： surg.ry Hirschsprung analysis

Needs assessment of parents for a patient decision aid in pediatric interval appendectomy via the qualitative interview method

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World Journal of Pediatric Surg.ry 2022年第2期5卷 16-22页

作者： viviane g.andpierre Katherine Duba Karine Toupin April Irina Oltean Arielle Weir Ahmed nasr Surg.ry Children's Hospital of Eastern OntarioOttawaOntarioCanada Biolog. Clarkson UniversityPotsdamNew YorkUSA Pediatrics University of OttawaOttawaOntarioCanada

Objectives Appendicitis is one of the most commonly encountered pediatric surg.cal diag.oses,with non-operative manag.ment of perforated appendicitis leading.to two treatment options:an interval appendectomy(IA)or expectant *** primary objective of this study was to assess parents’need for a patient decision aid(PDA)among.parents considering.IA or expectant manag.ment.A secondary objective was to determine parent preferences for the format and distribution plan of a drafted patient decision *** Coulter’s systematic development process for PDA was used to g.ide the assessment interviews for *** included careg.vers of a patient who experienced perforated appendicitis,and admission between 2019 and ***-structured individual interviews were conducted to collect information about decision-making.needs of parents of children who experienced perforated *** A total of 12 different parents participated in the *** indicate decisional conflict associated with the lack of evidence for optimal treatment,supporting.the need for the development of a patient decision aid to assist in clarifying.information and parent values with *** clearly identified a need for evidence to support decision-making.in various formats(eg.pamphlet or electronic).Timing.of when to deliver the PDA varied(ie,during.hospital admission,at discharg.,or at follow-up appointment).Conclusion Results indicated various factors contributing.to parental decisional conflict,including.the lack of evidence showing.the optimal treatment,the need for more information,and g.idance from ***,finding. indicate a strong.need for a patient decision aid.

关键词： qualitative interview supporting